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for Different Cases

A. Hoffer, M.D., Ph.D.1

ASCORBIC ACID CURE OF ONE CASE OF TOXIC

Recently when I was sorting out my reprints removed as treatment for cancer and then on ascorbic acid I ran across a complete file on received follow-up radiation. The skin over her my first psychotic patient given large doses of breast ulcerated. About five weeks before ascorbic acid alone. I have referred to this case admission she was given testosterone until 10 elsewhere, but have not given any clinical detail. days before. Since this may well be the first case ever treated Because of her severe agitation, depression, in this way, I think it may be useful to report the and paranoid delusions, ECT, the main details. treatment of that day, was indicated. Mrs. V. H., age 47, was referred to the By December 11, 1952, I had persuaded her General Hospital, Munroe Wing, Regina, doctor to allow me to treat her with megadoses because she was delusional, very depressed, and of ascorbic acid, my reasoning being that she threatened to kill herself. She was admitted was probably toxic from her cancer, radiation, December 9, 1952. and the ulceration. He agreed to hold off ECT She was large, obese, masculine in for a few days. appearance with a lot of hair on her face. Her She was started on 1 g of ascorbic acid each complexion was pale and muddy. She suffered hour while awake. If sleeping she was not from perceptual changes, hearing the voice of awakened, but when she did awaken was give her priest, she was confused, delusional, with no 1 g for each hour she had slept. insight, and was very agitated, restless, and depressed with marked mood swings. Progress Under Treatment About four years before her jealousy of her Between her admission December 9 and the husband suddenly became intense and she first administration of ascorbic acid there was accused him of having an affair with his no change in her psychosis. Ascorbic acid was secretary. She then threatened to kill herself. started 2:30 p.m., December 11, 1952 One year before she was admitted she had (Thursday). The following information is taken her right breast from the nursing notes:

1 #3 2727 Quadra St., Victoria, B.C. V8T 4E5.

169 ORTHOMOLECULAR PSYCHIATRY, VOLUME 5, NUMBER 3, 1976, Pp. 169-182

(1) December 12, 1952: ascorbic acid December 11. This day she sang A.M. —Patient slept eight hours. She ate a hymns and was fearful she would be harmed. large breakfast, stated she felt better, but On December 12 she was much more at ease, complained of feeling weak and of pain and mixed with other patients, and played cards burning over her ulcerated breast area. She well. On December 15 she was cheerful, no carried her Bible with her, praying frequently. longer expressed delusional ideas, and reported The pain in her breast, she stated, was there she was much better. On December 17 she because someone was praying for her to be remained well. She described how terrified she punished. had been prior to admission. People seemed to P.M. —The patient was more relaxed. She have changed and some appeared to be turkeys was friendly and affectionate with the nurses, or dodos with their intestines hanging out. She but required frequent reassurance that she would had felt everyone was going to be killed, but recover. She could not concentrate on anything. now she felt it was strange she could have felt (2) December 13, 1952: the way she did." There was no longer any A.M. —Patient was cheerful but quiet and no indication for ECT and she was discharged. longer sought reassurance. The ulcer had begun When I had first seen this patient I had to heal. Patient participated with the group and considered she had a toxic psychosis, but the enjoyed singing Christmas Carols with the radio. director of the unit to whom Dr. L. reported The ascorbic acid caused frequent bowel concluded she was schizophrenic. I still believe movements. I was correct. I am also convinced that the P.M. —Patient remained cheerful and quiet. massive doses of ascorbic acid promptly (3) December 14, 1952: brought her out of her psychosis and also Patient remained the same. She was seen initiated healing of the ulcerated lesion. This encouraging another patient who was very upset. had not responded to any previous treatment. If She missed her husband and was excited and she had not responded she would have been happy to see him. She did not carry her Bible given a series of ECT. Tranquilizers were then with her this day. not available. Improvement was noted within (4) December 15, 1952: 24 hours. She remained mentally well. She told the One could make the improbable hypothesis nurses, "I like Dr. L. better now and I really that she had made a placebo response. But don't mind being here as I'll be getting better." patients who have a toxic psychosis are not Later that day she felt well enough to go home. good candidates for placebo response. No Ascorbic acid was discontinued this day. attempt was made to convince her the (5) December 17, 1952: would help since none of the staff had any The patient stated she felt really good. For the reason for believing it would work, nor was she first time her breast ulcer was clean and healing my patient at any time, nor has it been found with no more purulent discharge. that faith can produce such a rapid response to (6) December 20, 1952: a serious infected radiation-induced ulcer. The patient was discharged December 20 I am sorry I did not keep her on ascorbic mentally normal. She remained normal until she acid much longer in view of the recent work by died six months later from her cancer. L. Pauling showing that megadoses of this Her psychiatrist recorded the following notes: vitamin had been helpful for some patients "December 15, 1952—Patient started on dying from cancer.

170 MEGAVITAMIN THERAPY FOR DIFFERENT CASES

MEGAVITAMIN TREATMENT FOR PSYCHIATRIC CHANGES

INDUCED BY MERCURY POISONING

Minamata disease, the result of chronic his nervousness he found himself more and mercury poisoning, has become a serious more depressed, and he began to experience problem in a few areas of Canada populated abnormal sexual impulses which led to chiefly by native people. Mercury dumped into antisocial behavior. About 17 days before he the water system contaminated fish which when was seen he had been transferred to another line ingested causes an increase in mercury levels. of work and was no longer exposed to mercury. The disease is named after a Japanese town By the time he saw me he was somewhat better. where it was first clearly recognized and A few months before he was seen he had a described. transient rash on his legs lasting one week Chronic exposure to mercury has long been which was itchy, and he noted he was very known to produce changes in the central nervous thirsty and his gums began to bleed when he system. In the past the main exposure has been brushed them. to inorganic mercury used in industry, but more His mental state was somewhat paranoid. He recently organic mercury has become more felt people were watching him continually, was important. There are differences in the way the convinced that his supervisor was talking about body deals with organic and inorganic mercury. him and was intentionally trying to harm him. The main difference is that organic mercury There was blocking, he could not remember as compounds penetrate more readily into the well and could not concentrate. He could read, brain, achieve higher CNS levels, and are but could not comprehend what he read. On excreted more slowly. occasion he suffered from . Apparently there is no effective treatment for In Cecil's Textbook of Medicine, Ninth Minamata disease. Perhaps one might develop. Edition, the symptoms of mercury intoxication Since 1969 I have been confronted with the included: necessity to treat three men who had suffered (1) with salivation, a metallic taste, inorganic mercury poisoning from prolonged ex- and a red-brown discoloration and gingivitis. posure to metallic mercury. One recovered, and (2) Increased irritability, increased shyness, the other two were much improved and on the insomnia, headache, vertigo, depression, and way to full recovery when last seen. This rarely hallucinations. suggests that a similar approach might be (3) Tremor of muscles of the face and limbs. therapeutic for some sufferers from Minamata (4) Loss of appetite and . disease, especially if started early. (5) , erythematous in form, and desquamation. The Three Cases The clinical picture, plus his exposure to mercury vapor, suggested he was poisoned by Case No. 1, Born in 1945, Male: mercury. A blood specimen was sent to the When first seen early in 1969 the patient laboratory. His mercury level was very high. complained of excessive nervousness for the Since the laboratory had hitherto run very few previous three months. Just before this happened mercury assays, it was not certain of the exact he had come into much closer contact with amount. mercury in his laboratory where he worked as a My final diagnosis was that he suffered from chemist. No provision had been made for proper an acute schizophrenic syndrome caused by ventilation of the laboratory, and he did not do mercury intoxication. As it was the preparations in a fume cupboard. With

171 ORTHOMOLECULAR PSYCHIATRY, VOLUME 5, NUMBER 3, 1976, Pp. 169-182

not very severe, I started him on nicotinic acid, 1 normal, but properly concerned over his g, q.i.d., since this is one of my main treatment previous behavior which he now was aware had components for schizophrenia, and on ascorbic been very abnormal. acid, 1 g, t.i.d. Ascorbic acid has been shown to Follow-up evaluation included the HOD test decrease the toxic effects of some heavy metal (Kelm et al., 1967; Hoffer and Osmond, 1961). poisoning including that from mercury. He was This is a card-sorting test designed to measure also given Diazepam, 10 mg, q.i.d., for about the experiential world (sensory) of patients. one and one-half months. Schizophrenics have high scores while normal He improved very rapidly and was almost subjects have low scores. His scores are shown normal one and one-half months after treatment on the table below. was started. The Diazepam was discontinued, but he remained on . When finally seen three months after his initial interview, he was

Since then he has not sought further help, was He complained that he was subject to no longer exposed to mercury vapor, and excessive daydreaming, felt unreal. He blocked, presumably remained well. his mind was in a fog, his memory became poor, and he could not concentrate. His Case No. 2, Born in 1929, Male: depression had lifted, but he remained very This patient was first seen October of 1974. tired. This patient was exposed to mercury fumes for I diagnosed him as an anxiety state due to over 15 years, but beginning in 1972 he was residual mercury intoxication. He was started exposed to increased quantities of mercury on nicotinic acid, 1 g, t.i.d., ascorbic acid, 1 g, droplets. After three months of this exposure he t.i.d., , 250 mg, one a day, and developed a marked tremor, became irrational penicillamine, 250 mg, b.i.d. and confused, indecisive, and very tired. He By June of 1975 he was much improved. described himself as being almost in a stupor. He Only the persistent roaring in his ears still was then admitted to hospital and given BAL for remained. He was less confused, more six weeks. He excreted 168 mg of mercury. May, confident, and his potency was normal. No 1971, he had 115 meg per liter of blood. After more follow-up interviews were required, and discharge he was no longer exposed to mercury, he has not sought any additional help. His HOD but remained tired and depressed for which he scores are shown on top of page 173. was given an antidepressant. This helped a little, but his personality was now altogether different. Case No. 3, Born 1936, Male: Normally, according to his wife, he was easy- This patient was first seen January, 1975. He going, friendly, outgoing, and cheerful. Now he began his exposure to mercury in 1958. In 1965 became irritable and introverted. His wife stated he developed what he described as weird living with him was like living on a symptoms. He be- powder keg. Also his sex drive disappeared.

172 MEGAVITAMIN THERAPY FOR DIFFERENT CASES

Paranoid Depression Schizophrenia Total Perceptual 2 16 4 October, 1974 99 21 1 7 3 June, 1975 42 11 0-3 0-3 0-1 Normal scores 0-30 0-3 Short Form for

came nervous, irritable, developed hysterical Mood —He was very depressed, irritable, and attacks, and later became depressed. He was fatigued, but not suicidal. diagnosed as having an anxiety state. In 1967 Behavior—At times his behavior had been blood mercury levels were very high. At that irrational. time the whole department which was exposed I diagnosed him as suffering from a to mercury became hyperirritable and were schizophrenic syndrome due to mercury considered screwballs by other workers. The intoxication. He was started on nicotinic acid, 1 more experienced workers began to avoid g, t.i.d., ascorbic acid, 1 g, t.i.d., thiamine, 250 mercury and sought help from the corporation mg per day, penicillamine, 250 mg, b.i.d., zinc and their union. Both ignored their complaints. sulphate 10 percent and manganese sulfate 1/2 When seen in January of 1975 this patient percent, 15 drops, b.i.d., and Diazepam, 5 mg, was still very depressed even though he had not p.r.n. been exposed to mercury for a long time. An Mercury values in January, 1971, were examination of the mental state revealed the 25 mcg per liter and in June, 1972, 10 mcg per following changes: liter. Perception —He felt people were watching By February of 1975 he was less irritable and him, had visual illusions seeing stars, geometric more relaxed. Three months later improvement patterns, and his own face altered as he looked at was steady but slow and nicotinic acid was it in the mirror. He heard a ringing in his ears, increased to 2 g, t.i.d. When seen last in August, heard his own thoughts, and heard the thoughts 1975, he was much improved to the point where of others and felt very unreal. he no longer needed to be seen. He had much Thinking—He was paranoid, delusional about more energy, no longer had severe outbursts of his union and employer, very jealous about his anger. I considered him nearly well. wife. There was severe blocking, his memory His HOD scores were: was erratic, and his concentration was very poor.

Short Form for Total Perceptual Paranoid Depression Schizophrenia

Retroactive for 12 8 12 1970 109 35 8 12 6 January 9, 1975 102 14 5 12 4 February 28 56 11 4 11 5 May 28 55 11 4 4 3 August 29 33 5 0-3 0-3 0-1 Normal Range 0-30 0-3

173 ORTHOMOLECULAR PSYCHIATRY, VOLUME 5, NUMBER 3, 1976, Pp. 169-182

Discussion lamine, to bind and excrete the heavy metal; Many more patients will have to be treated (d) extra zinc to replace what the chelator may before any firm conclusion is possible. Since I remove; have seen only these three cases and all (e) ascorbic acid which is a chelator for heavy responded, it is likely that in other series a metals and has been shown to alleviate toxic proportion will also respond, depending upon the symptoms produced by mercury and lead; degree of intoxication, amount of neurological (f) finally, the diet must be as nutritious as damage, and so on. Treatment should provide possible which to me means a sucrose-free diet. the following: REFERENCES (a) for restoration of cerebral psychiatric function—vitamin B3 ( or niacinamide) HOFFER, A., and OSMOND, H.: Journal of Neuropsychiatry 2, 306, 330, 1961. and are chiefly involved here; (b) to restore cerebral neurological function— KELM, H., HOFFER, A., and OSMOND, H.: Hoffer-Osmond Diagnostic Test Manual, 1967. thiamine is indicated for this by analogy with its use in the Korsakoff-Wernicke syndrome; Hod Manual,'Distributed by Dr. John McKee, Behavior Science Press, Box AG, University, Alabama, U.S.A., 35486. (c) a heavy metal chelator, e.g., penicil-

MEGAVITAMIN-INDUCED REMISSION OF ONE CASE OF HUNTINGTON'S CHOREA

Introduction Huntington's Chorea is a rare (5 per 100,000) Chorea have been described. It is found in every degenerative neurological disease first described country, but is more frequent among lower in 1841, although before that it was known by socioeconomic classes. These families also have the local population as "the magrums." George a high incidence of neurological disorders, Huntington in his now famous lecture, February alcoholism, mental deficiency, and insanity. 15, 1872, before the Meigs and Mason It usually begins between ages 20 and 50 with Academy, Middleport, Ohio, appeared to have a mean age of onset between 35 and 44. Only 10 described it as an afterthought. He considered it percent survive beyond 20 years, 70 percent die a form of Sydenham's Chorea with a tendency to within 15 years. Its course is "inexorably insanity and suicide, its appearance in adults, progressive." However Bruyn mentioned one and its dominant heredity. He did not consider it woman age 87 who developed symptoms at age important stating, "I have drawn your attention 14 (out of 120 cases). to this form of Chorea, gentlemen, not that I Clinically the disease is characterized by considered it of any great practical importance to involuntary movements involving many muscles you, but merely as a medical curiosity." This and muscle groups. Movements are slow and information and the clinical description which possess a waxing and waning property which follows is from an excellent description by eventually may become athetoid. Each patient Bruyn (1968). has a unique set of movements. Movement It has been traced back many centuries, but becomes awkward. At first patients appear there are no accounts of it before 1841. restless and fidgety with occasional grimaces Inheritance is due to a monohybrid autosomal which may be mistaken for tics. Partial opening gene with complete penetrance. Monozygotic of the mouth and spasmodic working of the twins concordant for Huntington's tongue and throat muscles become more

174 MEGAVITAMIN THERAPY FOR DIFFERENT CASES apparent especially when dysarthria develops. research into the biochemical lesions had not The voice loses much of its tonal force. yielded any significant Speech which is affected early in the illness leads. Perry et al. (1973) compared autopsied becomes dysarthric, explosive, hesitant, and brains of patients with chorea against control incoherent, spaced by long silences. subjects. There were two major differences. Swallowing and respiration become difficult. The choreac brains contained much lower Eye muscles are affected. When looking quantities of gamma amino butyric acid (GABA) laterally there are saccadic movements. and homocarnosine, a related substance in the Vertical gaze may become impossible. The substantia nigra, caudate nucleus, and putamen- head nearly always is in anteflexion, the chin globus pallidus while glycerophosphoethanola- resting on the sternum. mine concentrations were elevated. These authors Later choreatic movements become slower suggested that deficiency of GABA, a possible and more stereotyped. Muscles of the trunk inhibitor of synaptic transmission in the brain, are involved. Gait becomes uncertain and might be responsible for the symptoms. This unsteady. The length of the steps is irregular, could result from reduced activity of the enzyme and turning presents major difficulty. Muscle glutamic acid decarboxylase. force remains unimpaired, but sustained con- Bird et al. (1973) measured the activity of traction is broken by sudden relaxation. glutamic acid decarboxylase (GAD) in Fatigue is very common. postmortem brains of 14 cases. Its activity was Psychiatric symptoms nearly always are reduced by 80-90 percent in the basal ganglia. present and come on long before there are Stahl and Swanson (1974) also found a marked somatic changes. The patients develop reduction in GAD activity. changes in perception, thought, mood, and The only definite finding, therefore, is a behavior. Perceptual changes are rare. reduction in GAD, the enzyme which converts Thought disorder develops. Delusions of glutamic acid to gamma amino butyric acid, and grandeur are common, or may take any a decrease in GABA. Another interesting finding paranoid form. Concentration is not impaired, is that these changes occur in the darkly and confusional states or delirium are not pigmented areas of the brain, the substantia nigra, seen. Mood changes are frequent. The caudate nucleus. In these areas the pigment is knowledge that one may develop and later believed to arise from noradrenalin and adrenalin does have this disease produces anxiety, and to form quinoid melanins (from noradreno- depression with suicide is not uncommon. chrome and adrenochrome, Hoffer and Osmond, Patients later are quick and ill-tempered, 1967). In albinos who lack the enzyme necessary irascible, moody, and obstinate. Very late in to oxidize dopa to dopachrome these areas of the the illness, with progressive the brain retain their normal color. Finally, it has patient may develop euphoria. Behavior is been known for many years that adrenochrome is affected, and 20 percent of all patients have one of the most powerful inhibitors of glutamic been punished for criminal behavior before the acid decarboxylase. disease was diagnosed. Because Huntington's Chorea is so rare it is When psychosis develops early in the very difficult to gather a series. In nearly 25 years illness, the first three years, it tends to be of practice as a psychiatrist I have seen only one schizophrenic in form. A second peak case. This one case is the subject of this report. incidence occurs during the middle third of the After 20 years of gradual but progressive illness and is then more like an organic deterioration, this process was halted and psychosis. reversed by megavitamin therapy. Since so far no According to Bruyn (1968) the rather scanty one has reported such a similar

175 ORTHOMOLECULAR PSYCHIATRY, VOLUME 5, NUMBER 3, 1976, Pp. 169-182 event, I believe it is important that it be was getting messages from God. At times he had recorded so that other physicians who run marked choreiform movements. across cases of this dreadful disease will He was first committed to the mental hospital attempt a similar therapeutic regime. It is in 1930 and diagnosed as involutional important to determine whether my case is the melancholia. After discharge he was slightly only one who will respond in this way, improved. whether he represents a subgroup of During his prolonged stay in hospital he Huntington's Chorea, or whether a major occasionally suffered from hallucinations. He portion may be expected to respond. was reluctant to discuss these. He died of cerebral hemorrhage. Case History His father had been mentally unstable for a Mr. A., born February, 1913, consulted me number of years, and one brother was similar to October, 1973, complaining of nervousness the patient for about three years when he died. present since he was 40, but much more severe One sister was normal. over the previous year. He had no appetite, Siblings: Mrs. A. brought in the following was weak and tired, and had gone down in account of the five brothers: weight from 165 pounds when he was 40 to (a) Born 1908—As a boy he was very his weight of 130 pounds. He had been aware shy and showed extreme embarrassment. of marked muscle wasting which was He carried his head tipped to one side, generalized. He was so weak that his main had noticeable hand gestures, and a preoccupation had to do with the routine loose movement of his legs. These necessities of survival, eating, dressing, and so gradually worsened as he matured. on. However, he was intelligent, a good With his wife they had become very student, and served in the RCMP until interested in nutrition, and they had both gone failing health forced an honorable dis onto a -free, high- diet. He had charge when 38. Two years later he quit smoking one year before and felt that this became quarrelsome, irritable, corn- had been helpful. Five years before he had plaintive, withdrawn, and lost self- consulted a psychiatrist who, he stated, had confidence. He became paranoid, always not been helpful. blaming others. He lost weight rapidly, When I examined him there were no becoming emaciated. He entered a perceptual changes, his memory for recent convalescent home at age 64. Eventually events was poor, his concentration had he could no longer walk and speech deteriorated, and his thinking was interrupted became unintelligible. In 1973 he was by pauses (blocking). In his mood he was slightly better and was able to sit in a depressed, nervous, tense, very irritable, and recliner and able to say a few words. occasionally too angry at others. He suffered (b) Born 1909—Normal. from a peculiar obvious muscle twitch even (c) Born 1911 —Normal. when asleep. Occasionally he suffered from (d) Born 1913—Mr. A.'s wife des muscle in his legs and stumbled a lot cribed him as being very embarrassed as when he walked. a teenager and very nervous. He was very sensitive to pain and burns. In public his hands developed a tremor, but he was a Family History good student. When he reached 40 his personality changed from a quiet person Father—1876-1944: This man was re- ality and he became overbearing and admitted to mental hospital in 1932. He was adamant, withdrawn, and lacked con thin, had many purposeless movements of fidence. By age 55 he was no longer able arms, legs, body, and head, and was very to work enough to earn a living. By age restless. He was depressed and blamed 57 he could not work at all. He was very himself. He was also delusional, believing he

176 MEGAVITAMIN THERAPY FOR DIFFERENT CASES thin, and his muscles were wasted. He angered and he was started on , 400 units, b.i.d. easily and became irresponsible. Four months—There was no additional (e) Born 1915—Between 20 and 30 he improvement, but he had more insight and was became alcoholic and his personality concerned about his outbursts of anger against his deteriorated. At age 35 his movements became wife. He was now bored with nothing to do. awkward and he could not walk properly. At When first seen he was so busy staying alive he age 38 he joined AA. He now suffered severe had no time to be bored. All natural functions incoordination and often appeared drunk, but were normal. He began to consider going back to had not been drinking. At age 50 he was work. placed in a convalescent home. Six months—There was no change except his In 1973 he was badly deteriorated and weight had dropped to 125 pounds. Because of his unable to look after himself. He was unable to excessive fondness for dairy products and a prior speak at all, but appeared to understand when history of severe sinusitis I advised him to try a he was spoken to. He died in December, 1974. two-week dairy-free program. Seven months— Children —There are none. There was no improvement on dairy-free and he Diagnosis—Anxiety state—Huntington's resumed consumption of dairy products. He had Chorea. not gained any weight and was becoming weaker and tired more easily. I now concluded that the Treatment and Progress whole megavitamin program had failed even (a) Dietary—He was advised not to eat though he felt much better, as he had lost five any food to which sugar had been added and pounds from the time I had first seen him (about to avoid all processed and refined foods. one pound per five weeks). The objective (b) Vitamins—ascorbic acid 1 g, t.i.d., evidence of overpowered the megavit, t.i.d. (each tablet contains 100 mg of subjective assessment of improvement. At this thiamine, 25 mg of , 100 mg of time I increased the vitamin E to 800 units, b.i.d. Pyridoxine, 200 mg of niacinamide, and 500 Eight months—His weight was about the same. mg of ascorbic acid. , 1 mg per Nine months—Weight went up to 127 pounds. week. Weight 130 pounds. Eleven months—Weight was 135 pounds. His One month —There was a sudden appetite was good. His wife reported his muscles improvement to a flatter plateau of health were regaining their size, tone, and power. He where he remained. He felt much less remained normal mentally. In order to study the depressed, was stronger physically, and had effect of more vitamin E it was doubled to 3,200 fewer muscle cramps. His concentration was units per day. The niacin was reduced to 1/2 g, better. He had been able to work outside on t.i.d. He had normal energy and his chest which his roof. This had been the first useful work he had been drawn in regained its normal size. All had done in many years. Niacin, 1 g, t.i.d., and muscle tremor and cramps were gone. They both folic acid, 5 mg, b.i.d., were added plus felt the major change came when the vitamin E magnesium sulfate in solution to provide had been doubled from 800 to 1,600 units per day. magnesium. Thirteen months —His weight continued to Two months—He reported he stumbled less increase reaching 139 pounds. He became so often, only occasionally had cramps, but noted active physically it settled down between 135 and no other change. He was free of depression 136 pounds. Niacin was replaced by niacinamide and stated if he had to stay at his present level 1/2 g, t.i.d., because he felt niacin caused his nose of improvement the rest of his life he would be to swell. There was still a slight content. The niacin was doubled to 2 g, t.i.d.,

177 ORTHOMOLECULAR PSYCHIATRY, VOLUME 5, NUMBER 3, 1976, Pp. 169-182 unsteadiness when walking when he was I started them on the megavitamin program for excited. the following reasons: Fourteen months—He continued to improve Vitamin E—Because of a clear relationship steadily and no longer had outbursts of anger. between muscular dystrophy in animals and lack Fifteen months—He had suffered a cold and of vitamin E, and because of the severe loss of lost several pounds which he regained rapidly. weight and loss of muscle mass in Huntington's Before the cold he had been able to shovel Chorea and muscular dystrophy, it seemed snow. One year ago he had not been able to do appropriate to consider this vitamin in any work for longer than 10 minutes. He was megadoses. again started on niacin, 1/2 g, t.i.d. Vitamin B3 — A large number of studies Seventeen months —He and his wife reported have shown that large doses of this vitamin when he was now as well as he had been before the combined with other components of an onset of his illness at age 40. Niacinamide was Orthomolecular program substantially improve increased to 1 g, t.i.d., to try and improve the outcome (Hawkins and Pauling, 1973). I have weight gain which still remained around 135. been using it since 1952 in double-blind, single- Nineteen months—He was taken off niacin to blind, and clinical studies, and have concluded it see if he still required it. (He was still getting is therapeutic. Since my patient was beginning to 600 mg per day of niacinamide). show psychiatric symptoms it appeared to me Twenty months—Normal but slightly more wise to also give him this vitamin. His relapse irritable. He was given Diazepam, 5 mg, p.r.n. over one month when it was discontinued proved Twenty-two months—He reported that about this was a good decision. two weeks after he discontinued niacin he Other B vitamins—These were added merely became very restless and nervous and would to balance up the water-soluble vitamin program. tighten up his body frequently. He resumed Ascorbic Acid—This was also added to niacin medication, 1/2 g, t.i.d., and within a balance up the vitamin program and also to few days he was much better, but he lost three decrease the tendency for infection and colds. My pounds reaching 132 for the first time in a observation on over 20 years of prescribing year. When he walked his legs became stiff. ascorbic acid have convinced me of its value (Stone, 1972). Discussion When this patient first approached me I Polypharmacy could offer no treatment. I was convinced then It is passing strange how the meaning of that this was a progressive deteriorating words becomes corrupted. Polyphar-makos disease for which there was no treatment and originally meant a physician skillful in the use of from which no one recovered. The patient and drugs. By many it has become corrupted to mean his wife were very knowledgeable about the that too many drugs are being used on one disease and expected no cure. They had sought patient. The use of a large number of vitamins me out because they had heard of my may appear to be the latter sort of activity, but if association with the use of megavitamins. They we get away from the single - single had on their own started on a regime for disease idea so common among nutritionists and improving their nutrition; they merely wanted if it is remembered that there is no treatment, then my advice on the best possible combination of it is rational to use everything which might vitamins. I advised them that the most that they conceivably help the patient. The clinician is could expect would be a strengthening of his interested in the welfare of his resistance against the ravages of the illness.

178 MEGAVITAMIN THERAPY FOR DIFFERENT CASES patient. It would be preferable to know exactly suggested that adrenochrome was involved in the which chemicals are important. There are two etiology of schizophrenia. The arguments pro and ways this can be done: (a) By starting with one con are discussed in Hoffer and Osmond (1967). nutrient at a time, allow it to work for a It is possible that adrenochrome (or nor- reasonable period of time, then to try another adrenochrome) is also involved in Huntington's one. On one case double blind is impossible, Chorea. This is suggested by the following but with Huntington's Chorea not necessary evidence: since there have been no recoveries ever 1. Adrenochrome is a powerful inhibitor of published. The double-blind approach would glutamic acid decarboxylase. This would lead to satisfy the purist who sees no problem in a decrease in GAD levels and in GABA levels, as waiting decades, but it would not satisfy the has been found by Perry et al. (1973) and Bird et patient whose life expectancy is measured in al. (1973). years, not decades. (b) By starting with what 2. This occurs primarily in the pigmented might be helpful. If there is no response, then basal areas of the brain where the melanin is one can conclude none of the are of probably of noradrenalin or adrenalin origin, not value. If there is a response it shows that one or from tyrosine. a combination are effective. Once the patient 3. The psychosis of Huntington's Chorea has has been improved one can at one's leisure a schizophrenic quality in its early stages. withdraw one at a time and hopefully will be If this hypothesis is correct, one can account left with the ones which are effective. for the therapeutic action of the vitamins as It now appears from my study of this case so follows: far that at least vitamin E and nicotinic acid in Vitamin E—By reducing peroxidation and megadoses are essential. On the comprehensive decreasing formation of the chromes derived program given him for seven months including from the sympathomimetic amines. vitamin E, 800 units per day, there was a Nicotinic Acid—Increasing general improvement but his weight continued dinucleotide levels would decrease the to deteriorate, an ominous sign. He was oxidation of these amines (see Hoffer and beginning to get weaker as well. The month Osmond, 1967). Pyridoxine—Increasing after the vitamin E was doubled to 1,600 units conversion of into NAD would have a there was a major improvement, and for the similar effect. first time in many years the steady drift Ascorbic Acid—By inhibiting oxidation of the downward in weight was reversed and he amines. gained. He gained eight pounds in two months. Vitamin E has been described as a vitamin in This gain continued until he reached 139 search for an indication (Tappel, 1973). This is pounds when his increased physical exertion the general opinion of most nutritionists. and ability to be more active settled it down at However, many clinicians are convinced that around 135 pounds. When the nicotinic acid many indications exist already. They point to a was eliminated he began to relapse within two huge number of clinical reports which suggest weeks with a marked increase in restlessness that a few conditions do respond rather well to and nervousness. He promptly went back on, vitamin E therapy. Unfortunately many of the but his weight had dropped rapidly to 132 clinical studies were developed before the so- pounds, the largest drop over a similar interval called double-blind controlled experiment be- since he had become my patient. These changes came popular. Since then it is a general belief in relation to his medication therefore suggest among most medical investigators until it has that both vitamin B3 and vitamin E are been hallowed by the double blind with a important. Many years ago my colleagues and I significant difference over

179 ORTHOMOLECULAR PSYCHIATRY, VOLUME 5, NUMBER 3, 1976, Pp. 169-182 the 5 percent level of probability. The fact is inadequate intake of vitamin E would lead to the that no one has yet run that crucial experiment formation of highly reactive lipid peroxides in to determine that the double-blind both skeletal muscle and in the myocardium. methodology does what it is supposed to do Vitamin E has been recommended for theoretically. It has never been established by treatment of certain myocardial diseases (Shute experiment. It is like using a method for and Taub, 1969), for prevention and treatment of measuring levels which has never leg cramps (nocturnal leg cramps restless legs been standardized against any previous syndrome, Cathcart, 1972; Ayres, 1972), for method. Because few of the vitamin E studies management of arteriosclerotic occlusive have been double blind, few physicians have vascular disease (Toone, 1967), for intermittent been interested as a class. A large number do claudication (Williams et al., 1971), and use it for their own families and for their germ oil helped 13 out of 107 patients with a patients. If we define as a megadose a level of variety of neuromuscular disorders (Rabinovitch 800 I.U. (mg) per day or more, then we find et al., 1951), some of them dramatically. that all studies can be divided into two classes: There is thus evidence linking vitamin E with (a) those under 800 mg, usually under 400— muscular dystrophy. In order to establish a firm most of these studies have been negative; (b) relationship a long-term study will be required those over 800 I.U. —most of these have using megadoses of vitamin E. It will have to be yielded positive results. combined with an optimal diet and fortified with I have been interested in the relationship of and vitamin D3 to balance out the vitamin E to muscle . It is now intake of vitamin E. established that will The old idea of one vitamin-one disease is- no produce muscular dystrophy with stiffness, longer correct, useful, or adequate. lameness, and in a variety of farm So far no other program has been successful animals, but also in the monkey (see Roche, although modern therapeutic agents have been Vitamin E for Farm Animals). The deficiency helpful in controlling one or another facet of the is worse if there is also a deficiency of illness. For this reason I would suggest that other selenium, or with an excess of polyunsaturated cases with Huntington's Chorea be started on a fats. Roche concluded, "It can no longer be similar broad-spectrum, megavitamin nutritional assumed that natural foodstuffs will always approach. provide physiologically optimal levels in It would then be possible to determine how rations," especially since the turnover of many would respond, not just by some slight vitamin E is rapid and it cannot be stored like improvement, but by restoration of normal vitamin A. function. If more patients do respond, it might be Human muscular dystrophy has not possible to hypothesize that Huntington's Chorea responded to smaller doses of vitamin E, but is a vitamin E-dependency disease coming on this should not be surprising. Anderson (1973) during adulthood, perhaps as a result of a chronic pointed out that short-term trials with vitamin E deficiency. antioxidant supplementation would not show But due attention must also be given to the any significant reduction in the incidence of possible role of food allergies. myocardial infarction. Once lipid peroxides As a rule one case is not convincing except in have been incorporated into tissues their a hopelessly deteriorating disease like removal is slow and difficult. This would also Huntington's Chorea where it becomes as apply to dystrophic muscle. In this report important as one white crow in a flock of many Anderson concluded that a combination of blacks. It brings attention to the possibility of a increased dietary unsaturated fatty acids plus new treatment approach. Two cases would be

180 MEGAVITAMIN THERAPY FOR DIFFERENT CASES even more impressive. There is such a case noted her muscles were firmer. Her weight which came to my attention. The information stabilized at 126 pounds where it is today. She. was given to me by the patient's husband. I was now on a vegetarian diet fortified with other have not examined her as she does not B vitamins and vitamin B12. All her live in North America. On April 17, 1975, gastrointestinal complaints such as constipation, her husband reported that his wife, age 32, had etc., cleared. She was more relaxed and had few first suffered symptoms at 19, slurred speech, outbursts. She remained nearly well except she lack of facial expression. Her father died continued to have difficulty in speech, had psychotic in a mental hospital about one year difficulty doing simple tasks, required more rest. after admission. The symptoms came on Early in 1975 she was examined because of a after the birth of her second child. They were sore throat and her husband was given a very primarily psychiatric-frequent episodes of poor prognosis. At the beginning of June the depression and excitability. They both vitamin E was increased to 1,600 I.U. There was became aware that these outbursts tended to a prompt improvement and she can now go on come after certain meals and stresses such as walks which she had been too tired to do before. cold, fatigue, or too long an interval between When this report was prepared (October, 1975) eating. They began to eliminate certain foods, she was still improving. especially meats, and her furious outbursts gradually subsided. At age 22 she developed REFERENCES fearful nightmares and a nervous tic and involuntary winking. At 24 she was diagnosed ANDERSON, T. W.: Nutritional Muscular Dystrophy and Human as Huntington's Chorea and advised there Myocardial Infarction. The Lancet 2, 298-302, 1973. was no treatment and to prepare for her AYRES, S.: Leg Cramps and Vitamin E. J.A.M.A. 219, 216, 1972. inevitable deterioration and death. At 24 her movements were very jerky and she developed BIRD, E. D., MacKAY, A. V. P., RAYNER, C. N„ and IVERSEN, L. L.: Reduced Glutamic Acid Decarboxylase Activity of Post a pin-rolling movement of her hands. She was mortem Brain or'Huntington's Chorea. The Lancet 1, 1090-1092, again diagnosed at the neurological unit of a 1973. large hospital and started on Librium and BRUYN, G. W.: Huntington's Chorea From Handbook of Clinical Tetrabenazine. The only change was an . Ed.: Vinken, P. J., and Bruyn, G. W. John Wiley and improvement in tremor. Sons Inc., New York, pp. 298-378, 1968. By now she weighed 238 pounds (57") due CATHCART, R. F.: Leg Cramps and Vitamin E. J.A.M.A. 219, to her excessive craving for sweets and her 216, 1972. habit of eating up to eight meals per day. HAWKINS, D. R., and PAULING, L: Orthomolecular Psychiatry. Suddenly her weight began to drop and by age W. H. Freeman and Sons, San Francisco, 1973. 28 she was 140 pounds and still dropping. She HOFFER, A., and OSMOND, H.: The Hallucinogens. Academic was also weaker, her muscles were thin, soft, Press, New York, 1967. and wasted. When she was 29 (three years ago) PERRY, T. L., HANSEN, S„ and KLOSTER, M.: Huntington's her husband read the book by Shute and Taub Chorea. New England Journal of Medicine, 288,-337-342, 1973. (1969) on vitamin E where Huntington's RABINOVITCH, R., GIBSON, W. C, and McEACHERN, D.: Neuromuscular Disorders Amenable to Wheat Germ Oil Therapy Chorea was not discussed. But he reasoned that Neurol. Neurosurgery, Psychiatry 14, 95-100, 1951. it might improve the micro circulation and thus SHUTE, W. H., and TAUB, H. J.: Vitamin E for Ailing and Healthy improve oxygenation. He started her on vitamin Hearts. Pyramid House, New York, 1969. E, 200 I.U., once a day. Very soon she was STAHL, W. L., and SWANSON, P. D.: Biochemical Abnormalities brighter, more energetic, so he doubled it to in Huntington's Chorea Brains. Neurology 24, 813-819, 1974. 400 I.U. The results were astonishing; whereas STONE, I.: The Healing Factor. Against Disease. before she had to be in bed by 8 p.m. she Grosset and Dunlap, New York, 1972. could now go to parties and stay awake until 5 TAPPEL, A. L.: Vitamin E Nutrition Today 4-12, 1973. a.m. After increasing the dose to 600 I.U. he

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TOONE, W. M.: The Management of Arteriosclerotic Occlusive Vascular Disease with Poor Distal Run off. Angiology 18, 409- 414, 1967. WILLIAMS, H. T. G., FENNA, D., and MacBETH, R. A.: Alpha in the Treatment of Intermittent Claudication. Surgery, Gynecology and Obstetrics 132, 1971. 182